Provider Demographics
NPI:1154490829
Name:CHU, FELICIA
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:CHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N MCLEAN BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-3220
Mailing Address - Country:US
Mailing Address - Phone:847-697-9000
Mailing Address - Fax:847-697-3326
Practice Address - Street 1:320 N MCLEAN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-3220
Practice Address - Country:US
Practice Address - Phone:847-697-9000
Practice Address - Fax:847-697-3326
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice